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Rep. Paul Ryan, R-Wis., and Sen. Patty Murray, D-Wash., spent the last days of their budget negotiations haggling over an extension of emergency unemployment benefits, which, thanks to Republican objections, didn’t make it into the final agreement, and will probably lapse for over a million out-of-work Americans between Christmas and New Year’s.

Fast-forward to Wednesday evening, when the powerful House Rules Committee convened to tee up a floor vote on the Murray-Ryan bill. Before they adjourned, committee Republicans made a significant adjustment to it. They tacked on three-month legislation protecting physicians from an automatic cut in Medicare reimbursements, and (for technical reasons) actually increased their fees by half a percent.

In an economy with weak labor demand, Republicans declared extending unemployment benefits a deal breaker but happily protected wealthy doctors from any hardship and actually gave them a small winter raise.

As failures of libertarian populism and reform conservatism go, this isn’t quite as egregious as Republican efforts to lavish subsidies on wealthy farmers while simultaneously slashing food stamps by billions of dollars. But it’s an outgrowth of the same value system. And it comes at a time when GOP leaders are trying to refashion themselves as tribunes for the poor.

Ryan himself is spearheading an anti-poverty initiative (details to come). House Majority Leader Eric Cantor wants the party to shift its focus from internal strife to “solving the problems people are facing.”

Now I don’t think allowing Medicare physician reimbursements to drop by over a quarter all at once is a great way to solve the problems people are facing. The consequences probably wouldn’t be as severe as the AMA would have you believe, but I understand why Congress feels there’s an urgent need to avoid them anyhow.

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At the same time, there are three unemployed people for every job opening in the country right now. Even if you agree with overstated claims about the perverse incentives unemployment benefits create, kicking millions of them off of unemployment in this job market isn’t going to solve the problems they’re facing.

I’m struggling to construct a consistent conservative argument for using the budget bill as a vehicle for a so-called “doc fix” but foreclosing on the idea of allowing an unemployment extension to ride shotgun. I could fashion one for allowing both to lapse. Or for requiring the costs of both to be offset independently of the provisions in the budget bill (I wouldn’t agree with either argument, but the arguments would cohere).

Rules Committee Democrats would’ve supported the doc fix unanimously, too, if unemployed people had been given the same basic treatment.

But the only case for shafting the jobless, while tacking a pay increase for doctors onto the deficit, is a religious belief that what our unequal, job-constrained society needs right now is more welfare for the rich and less for the poor.

Brian Beutler is Salon's political writer. Email him at bbeutler@salon.com and follow him on Twitter at @brianbeutler.